Intravascular implants

ABSTRACT

A radially expandable, tubular stent, includes a first section having a first crush resistance force and a second section have a second crush resistance force, wherein the first crush resistance force is less than the second crush resistance force. The first section is connected to the second section to form a tube, connection of the first and second sections extending in an axial direction of the tube.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.15/471,980, filed Mar. 28, 2017, which is a non-provisional applicationof, and claims the priority benefit of, Provisional Application Ser. No.62/316,128, filed Mar. 31, 2016, each of which is hereby incorporated byreference in its entirety for all purposes as if fully set forth herein.

BACKGROUND Field of the Invention

Disclosed herein are stents for implantation within the body and methodsfor delivery and/or deployment. Certain embodiments disclosed herein maybe used in procedures to treat May-Thurner syndrome and/or deep venousthrombosis and the resulting post-thrombotic syndrome.

Description of the Related Art

May-Thurner syndrome, also known as iliac vein compression syndrome, isa condition in which compression of the common venous outflow tract ofthe left lower extremity may cause various adverse effects, including,but not limited to, discomfort, swelling, pain, and/or deep venousthrombosis (DVT) (commonly known as blood clots). May-Thurner syndromeoccurs when the left common iliac vein is compressed by the overlyingright common iliac artery, leading to stasis of blood, which may causethe formation of blood clots in some individuals. Other, less common,variations of May-Thurner syndrome have been described, such ascompression of the right common iliac vein by the right common iliacartery.

While May-Thurner syndrome is thought to represent between two to fivepercent of lower-extremity venous disorders, it frequently goesunrecognized. Nevertheless, it is generally accepted that May-Thurnersyndrome is about three times more common in women than it is in men andtypically manifests itself between the age of twenty and forty. Patientsexhibiting both hypercoaguability and left lower extremity thrombosismay be suffering from May-Thurner syndrome. To confirm that diagnosis,it may be necessary to rule out other causes for hypercoagulable state,for example by evaluating levels of antithrombin, protein C, protein S,factor V Leiden, and prothrombin G20210A.

By contrast to the right common iliac vein, which ascends almostvertically parallel to the inferior vena cava, the left common iliacvein takes a more transverse course. Along this course, it lies underthe right common iliac artery, which may compress it against the lumbarspine. Iliac vein compression is a frequent anatomic variant—it isthought that as much as 50% luminal compression of the left iliac veinoccurs in a quarter of healthy individuals. However, compression of theleft common iliac vein becomes clinically significant only if suchcompression causes appreciable hemodynamic changes in venous flow orvenous pressure, or if it leads to acute or chronic deep venousthrombosis, which will be discussed in more detail below. In addition tothe other problems associated with compression, the vein may alsodevelop intraluminal fibrous spurs from the effects of the chronicpulsatile compressive force from the overlying artery.

The narrowed, turbulent channel associated with May-Thurner syndrome maypredispose the afflicted patient to thrombosis. And, the compromisedblood flow often causes collateral blood vessels to form—most oftenhorizontal transpelvis collaterals, connecting both internal iliac veinsto create additional outflow possibilities through the right commoniliac vein. Sometimes vertical collaterals are formed, most oftenparalumbar, which can cause neurological symptoms, like tingling andnumbness.

Current best practices for the treatment and/or management ofMay-Thurner syndrome is proportional to the severity of the clinicalpresentation. Leg swelling and pain is best evaluated by vascularspecialists, such as vascular surgeons, interventional cardiologists,and interventional radiologists, who both diagnose and treat arterialand venous diseases to ensure that the cause of the extremity pain isevaluated. Diagnosis of May-Thurner syndrome is generally confirmed oneor more imaging modalities that may include magnetic resonancevenography, and venogram, which, because the collapsed/flattened leftcommon iliac may not be visible or noticed using conventionalvenography, are usually confirmed with intravascular ultrasound. Toprevent prolonged swelling or pain as downstream consequences of theleft common iliac hemostasis, blood flow out of the leg should beimproved/increased. Early-stage or uncomplicated cases may be managedsimply with compression stockings. Late-stage or severe May-Thurnersyndrome may require thrombolysis if there is a recent onset ofthrombosis, followed by angioplasty and stenting of the iliac vein afterconfirming the diagnosis with a venogram or an intravascular ultrasound.A stent may be used to support the area from further compressionfollowing angioplasty. However, currently available stenting optionssuffer from several complications—including severe foreshortenting, lackof flexibility (which can force the vessel to straighten excessively),vessel wear and eventual performation, increased load on and deformationof the stent causing early fatigue failure, and/or impedence of flow inthe overlying left iliac artery potentially causing peripheral arterialdisease. The compressed, narrowed outflow channel present in May-Thurnersyndrome may cause stasis of the blood, which an important contributingfactor to deep vein thrombosis.

Some patients suffering from May-Thurner syndrome may exhibit thrombosiswhile others may not. Nevertheless, those patients that do notexperience thrombotic symptoms may still experience thrombosis at anytime. If a patient has extensive thrombosis, pharmacologic and/ormechanical (i.e., pharmacomechanical) thrombectomy may be necessary. Thehemostasis caused by May-Thurner syndrome has been positively linked toan increased incidence of deep vein thrombosis (“DVT”).

Deep vein thrombosis, or deep venous thrombosis, is the formation of ablood clot (thrombus) within a deep vein, predominantly in the legs. Theright and left common iliac are common locations for deep veinthrombosis, but other locations of occurrence are common. Non-specificsymptoms associated with the condition may include pain, swelling,redness, warmness, and engorged superficial veins. Pulmonary embolism, apotentially life-threatening complication of deep vein thrombosis, iscaused by the detachment of a partial or complete thrombus that travelsto the lungs. Post-thrombotic syndrome, another long-term complicationassociated with deep venous thrombosis, is a medical condition caused bya reduction in the return of venous blood to the heart and can includethe symptoms of chronic leg pain, swelling, redness, and ulcers orsores.

Deep vein thrombosis formation typically begins inside the valves of thecalf veins, where the blood is relatively oxygen deprived, whichactivates certain biochemical pathways. Several medical conditionsincrease the risk for deep vein thrombosis, including cancer, trauma,and antiphospholipid syndrome. Other risk factors include older age,surgery, immobilization (e.g., as experienced with bed rest, orthopediccasts, and sitting on long flights), combined oral contraceptives,pregnancy, the postnatal period, and genetic factors. Those geneticfactors include deficiencies with antithrombin, protein C, and proteinS, the mutation of Factor V Leiden, and the property of having a non-Oblood type. The rate of new cases of deep vein thrombosis increasesdramatically from childhood to old age; in adulthood, about 1 in 1000adults develops the condition annually.

Common symptoms of deep vein thrombosis include pain or tenderness,swelling, warmth, redness or discoloration, and distention of surfaceveins, although about half of those with the condition have no symptoms.Signs and symptoms alone are not sufficiently sensitive or specific tomake a diagnosis, but when considered in conjunction with known riskfactors can help determine the likelihood of deep vein thrombosis. Deepvein thrombosis is frequently ruled out as a diagnosis after patientevaluation: the suspected symptoms are more often due to other,unrelated causes, such as cellulitis, Baker's cyst, musculoskeletalinjury, or lymphedema. Other differential diagnoses include hematoma,tumors, venous or arterial aneurysms, and connective tissue disorders.

Anticoagulation, which prevents further coagulation but does not actdirectly on existing clots, is the standard treatment for deep veinthrombosis. Other, potentially adjunct, therapies/treatments may includecompression stockings, selective movement and/or stretching, inferiorvena cava filters, thrombolysis, and thrombectomy.

BRIEF SUMMARY OF THE INVENTION

Accordingly, the present invention is directed to an intravascular stentthat obviates one or more of the problems due to limitations anddisadvantages of the related art.

An advantage of the present invention is to provide a radiallyexpandable, tubular stent, including a first section having a firstcrush resistance force and a second section have a second crushresistance force, wherein the first crush resistance force is less thanthe second crush resistance force; and the first section connected tothe second section to form a tube, connection of the first and secondsections extending in an axial direction of the tube.

In another aspect of the present invention, further embodiment of aradially expandable, tubular stent, includes a plurality ofcircumferentially adjacent closed cells defining at least two axiallyrepeating rings; and a plurality of linkage struts connecting respectiveones of the circumferentially adjacent closed cells, wherein theplurality of linkage struts is fewer than the plurality of linkagestruts such that fewer than the plurality of circumferentially adjacentclosed cells in adjacent rings are connected by a linkage strut.

Further embodiments, features, and advantages of the intravascularstent, as well as the structure and operation of the various embodimentsof the intravascular stent, are described in detail below with referenceto the accompanying drawings.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory only,and are not restrictive of the invention as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying figures, which are incorporated herein and form part ofthe specification, illustrate an intravascular stent. Together with thedescription, the figures further serve to explain the principles of theintravascular stent described herein and thereby enable a person skilledin the pertinent art to make and use the intravascular stent.

FIG. 1 shows an inferior-posterior view of the L5 lumbar and thebifurcations of the abdominal aorta and inferior vena cava.

FIG. 2 shows a schematic of the standard overlap of the right commoniliac artery over the left common iliac vein.

FIG. 3 shows a cross-sectional schematic of the arterio-venous systemshown in FIG. 2 taken along the gray dotted line.

FIGS. 4A-4C show an embodiment of an elliptical stent in three differentstates: FIG. 4A shows the stent uncompressed and unconstrained; FIG. 4Bshows the stent highly compressed for delivery; and FIG. 4C shows thestent deployed within a blood vessel.

FIG. 5A is an embodiment of an elliptical stent having bilaterallysymmetrical weaker sections and bilaterally symmetrical strongersections.

FIG. 5B is an embodiment of an elliptical stent having bilaterallyasymmetrical weaker sections and bilaterally asymmetrical strongersections.

FIGS. 6A-6B show an embodiment of the struts of the weaker sections ofthe stents of FIGS. 5A-5B.

FIGS. 7A-7B show an embodiment of the struts of the stronger sections ofthe stents of FIGS. 5A-5B.

FIG. 8A shows the stent of FIG. 5B in comparison to a maximum referencevessel diameter.

FIGS. 8B-8C show the stronger struts and the weaker struts of the stentof FIG. 8A when the stent is at the maximum reference vessel diameter.

FIG. 9A shows the stent of FIG. 5B in comparison to a minimum referencevessel diameter.

FIGS. 9B-9C show the stronger struts and the weaker struts of the stentof FIG. 8A when the stent is at the minimum reference vessel diameter.

FIG. 10A shows the stent of FIG. 5B held within the lumen of a deliverydevice.

FIGS. 10B-10C show the stronger struts and the weaker struts of thestent of FIG. 8A when the stent held within the lumen of a deliverydevice.

FIGS. 11A-11E are various views of an embodiment of an elliptical stenthaving stronger sections and weaker sections.

FIG. 12 shows the anatomical cross section of FIG. 3 with a circularstent deployed in the left common iliac vein.

FIG. 13 shows the anatomical cross section of FIG. 3 with an ellipticalstent deployed in the left common iliac vein.

FIG. 14 is a hybrid stent having a first section, a second section, anda third transitional section.

FIGS. 14A-14C show various views of an embodiment of a stent having bothhigh radial force and flexibility along its length.

FIG. 15 shows a “Z” strut of the stent shown in FIGS. 14A-14C in variouspositions.

FIG. 16 shows the individual components, including cells and flexiblebridge members of an embodiment of a stent.

FIG. 17 shows a cell geometry having a high radial force.

FIG. 18 illustrates a network of flexible constructs formed of cells andflexible bridge members.

FIGS. 19A and 19B show various flexible bridge member geometries.

FIGS. 20A-20H show various views of an implant having an expandedimplantation size that may be selectively adjustable across a range ofdiameters.

FIGS. 21A-21D show various views of an embodiment of a stent configuredto minimize foreshortening while retaining flexibility.

FIGS. 22A-22E show various views of an intravascular stent having aplurality of anchor members.

FIGS. 23A-23F show various potential configurations of anchors that maybe used with the intravascular stent of FIGS. 22A-22E.

DETAILED DESCRIPTION

May-Thurner syndrome, or iliac vein compression syndrome, occurs in theperipheral venous system when the iliac artery compresses the iliac veinagainst the spine as shown in FIG. 1. FIG. 1 illustrates a vertebra, theright and left common iliac arteries near the bifurcation of theabdominal aorta, and the right and left common iliac arteries near thebifurcation of the inferior vena cava. The bifurcations generally occurnear the L5 lumbar vertebra. Thus, it can be seen that FIG. 1 shows aninferior-posterior view of the L5 lumbar and the bifurcations of theabdominal aorta and inferior vena cava.

As shown, the strong right common iliac artery has compressed the iliacvein causing it to become narrowed. This is one possible, if not aclassic, manifestation of May-Thurner syndrome. Over time, suchnarrowing may cause vascular scarring which can result in intraluminalchanges that could precipitate iliofemoral venous outflow obstructionand/or deep vein thrombosis. As discussed above, venous insufficiency(i.e., a condition in which the flow of blood through the veins isimpaired) can ultimately lead to various deleterious pathologiesincluding, but not limited to, pain, swelling, edema, skin changes, andulcerations. Venous insufficiency is typically brought on by venoushypertension that develops as a result of persistent venous obstructionand incompetent (or subcompetent) venous valves. Current treatments forvenous outflow obstruction include anticoagulation, thrombolysis,balloon angioplasty and stenting.

FIG. 2 illustrates the standard overlap of the right common iliac arteryover the left common iliac vein. The arteries shown include theabdominal aorta 1500 branching into the left common iliac artery 1501and the right common iliac artery 1502. The veins shown include theinferior vena cava 1503 branching into the left common iliac vein 1504and right common iliac vein 1505. It will be understood that the roughdiagram illustrated in FIG. 2 represents the view looking down on apatient laying face-up (i.e., an anterior-poster view of the patient atthe location of the bifurcation of the abdominal aorta 1500 and theinferior vena cava 1503). The overlap of the right common iliac artery1502, which is relatively strong and muscular, over the left commoniliac vein 1504 can cause May-Thurner syndrome by pressing down on thevein 1504, crushing it against the spine, restricting flow, and,eventually, causing thrombosis and potentially partially or completelyclotting off of the left common iliac vein 1054 and everything upstreamof it (i.e., the venous system in the left leg, among others).

FIG. 3 illustrates a cross-section of the arterio-venous system shown inFIG. 2 taken along the gray dotted line. Shown in schematic are theright common iliac artery 1600, the left common iliac vein 1601, and avertebra 1602 of the spine (possibly the L5 lumbar vertebra of thelumbar spine). As can be seen, the right common iliac artery 1600 issubstantially cylindrical, due to its strong, muscular construction(among other potential factors). That strong, muscular artery haspressed down on the left common iliac vein 1601, until it has almostcompletely lost patency, i.e., it is nearly completely pinched off. Itwill be understood that May-Thurner syndrome may indeed involve suchsevere pinching/crushing of the underlying left common iliac vein 1601against the vertebra 1602 of the lumbar spine. However, it will also beunderstood that May-Thurner syndrome may involve much lesspinching/crushing of the underlying left common iliac vein 1601 againstthe vertebra 1602. Indeed, embodiments disclosed herein are appropriatefor the treatment of various degrees of May-Thurner syndrome, includingfull crushing/pinching of the left common iliac vein 1602 by the rightcommon iliac artery 1600. Other embodiments disclosed herein areappropriate for the treatment of various degrees of May-Thurnersyndrome, including, but not limited to a crush/pinch of the underlyingleft common iliac vein 1601 of between about 10-95%, about 15-90%, about20-85%, about 25-80%, about 30-75%, about 35-70%, about 40-65%, about45-60%, and about 50-55%, or any other crush/pinch that could merittreatment using one or more of the devices disclosed herein.

In some embodiments, a self-expanding elliptical stent is provided,including elliptical stents having a high crush resistance, but a lowradial force on the vessel wall. Therefore, some embodiments of stentsdiscussed herein, including elliptical stents, may be useful in thetreatment of May-Thurner syndrome. FIGS. 4A-4C illustrate an embodimentof an elliptical stent in various states: FIG. 4A shows the stentuncompressed and unconstrained (e.g., sitting on a table); FIG. 4B showsthe stent comparatively highly compressed for delivery within a patientand constrained by a delivery device (e.g., a catheter-base deliverydevice); finally, FIG. 4C shows the stent compressed and constrained byand within the left common iliac vein of a patient.

More specifically, FIG. 4A shows one embodiment of an elliptical stentin a first state (e.g., an uncompressed, unconstrained state) having anunconstrained cross-section with a first cross-sectional diameter 100(or diameter across a minor axis of an ellipse) in a first direction anda second cross-sectional diameter 101 (or diameter across a major axisof an ellipse) in a second direction (perpendicular to the firstdirection). As can be seen, when uncompressed, the first cross-sectionaldiameter 100 may be less than the perpendicular, second cross-sectionaldiameter thereby defining a substantially elliptical cross-section.

FIG. 4B illustrates the elliptical stent of FIG. 4A in a second state(e.g., a highly compressed state) having a crimped cross-sectional witha first cross-sectional diameter 120 in the first direction and a secondcross-sectional diameter 121 in the perpendicular, second direction. Ascan be seen, when compressed for delivery, the elliptical stent may havea first cross-sectional diameter that is substantially equal to itsperpendicular, second cross-sectional diameter—that is to say that whenin the second, highly compressed, or delivery, state, the ellipticalstent may have a cross sectional profile that is substantially circular.

FIG. 4C illustrates the elliptical stent of FIGS. 4A-4B in a third state(e.g., an implanted or deployed state) and deployed or placed within ablood vessel (e.g., a left common iliac vein). As shown in FIG. 4C, thestent may be placed within a vessel 132 and thereby be constrained orrestricted by the intraluminal wall of the vessel 132. As will be easilyunderstood, when deployed, the stent pushes outward to hold open thevessel 132 to maintain patency. FIG. 4C shows that after deployment, atleast some embodiments of the elliptical stents disclosed herein mainmaintain their elliptical cross-section to hold open the vessel 132 inan elliptical cross-sectional shape, rather than in a standard circularcross-sectional shape—that is to say that after deployment, the firstcross-sectional diameter 130 (or diameter across a minor axis of anellipse) in the first direction is less than the second cross-sectionaldiameter 131 (or diameter across a major axis of an ellipse) in theperpendicular second direction.

In some embodiments, the first cross-sectional diameter 100 when in theunconstrained first state is greater than the first cross-sectionaldiameter 130 when in the deployed third state, which is greater than thefirst cross-sectional diameter 120 when in the highly compressed secondstate. Stated more simply, the elliptical stent has a largercross-sectional diameter when uncompressed than when deployed in thelumen of a vessel. This is natural as the stent must be under somecompression when deployed to be of any use holding the vessel open. And,the stent has a smaller cross-sectional diameter when compressed into adelivery device than when uncompressed (e.g., on a table) or deployed ina vessel lumen. The stent must be able to traverse tortuous blood vesselsystems to arrive at its deployment location—and it must be smaller thanthe lumens through which it must pass, so as to not scrape and damagethe vessel walls.

As just discussed, some of the stents disclosed herein have anelliptical cross section (i.e., a first diameter across a minor axissmaller than a second, perpendicular diameter across a major axis). Insome embodiments of the elliptical (or other) stents disclosed herein,the stent generates a first radial force in the first cross-sectionaldirection (e.g., FIG. 4A 100) that is substantially equal to a secondradial force in the second cross-section direction (e.g., FIG. 4A 101).In other embodiments of the elliptical (or other) stents disclosedherein, the stent is advantageously capable of generating a first radialforce in the first cross-sectional direction (e.g., FIG. 4A 100) and adifferent, lesser second radial force in the perpendicular secondcross-sectional direction (e.g., FIG. 4A 101). In still otherembodiments of the elliptical (or other) stents disclosed herein, thestent generates a first racial force in the first cross-sectionaldirection (e.g., FIG. 4A 100) and a different, greater second radialforce in the perpendicular second cross-sectional direction (e.g., FIG.4A 101).

Some embodiments of the stents disclosed herein may have one or morestrong sections in the wall of the stent and one or more weak sectionsin the wall of the stent. By selectively positioning these strong andweak sections, the stent may be tailored to have selectivecrush-resistance. Various examples, which are not intended to beexhaustive, of such selective crush-resistance are discussed below.

FIG. 5A illustrates an embodiment of an elliptical stent havingbilaterally symmetrical weaker sections of the stent wall (e.g., strutsor other structures) and bilaterally symmetrical stronger sections ofthe stent wall (e.g., struts or other structures). The stent may have anelliptical cross-sectional shape (although it should be understood thatit may have other cross-sectional shapes, when uncompressed, highlycompressed, or deployed) in its uncompressed state that is symmetricalacross its center axis 702 (e.g., FIG. 4A 100) that is substantiallyperpendicular to the stent's longitudinal axis (which is generally thesame as the longitudinal axis of the blood vessel into which the stentis deployed, when deployed). As shown in FIG. 5A, the stent has twostronger sections 701 (e.g., reinforced sections, load bearing sections,etc.) that are separated by two weaker sections 700 (e.g., connectionportions). The strong sections 701 are shown as being symmetric acrossthe center axis 701 of the ellipse such that the stronger sections 701are positioned in the more convex portions of the ellipse. Such aconfiguration of strong sections 701 and weak sections 700 may create ahigher resistance to crush force in the vertical cross-sectionaldirection than the horizontal cross-sectional direction. And, the weaksections 700 may create a point where the stent is more susceptible tocollapse along the center axis 701 than the points working away from theaxis.

FIG. 5B illustrates an embodiment of an elliptical stent havingbilaterally asymmetrical weaker sections of the stent wall (e.g., strutsor other structures) and bilaterally asymmetrical stronger sections ofthe stent wall (e.g., struts or other structures). The stent may have anelliptical cross-sectional shape (although it should be understood thatit may have other cross-sectional shapes, when uncompressed, highlycompressed, or deployed) in its uncompressed state that is symmetricalacross its center axis 802 (e.g., the same as FIG. 4A 100) that issubstantially perpendicular to the stent's longitudinal axis (which isgenerally the same as the longitudinal axis of the blood vessel intowhich the stent is deployed, when deployed). Similar to the stent shownin FIG. 5A, the stent shown in FIG. 5B has two stronger sections 801(e.g., reinforced sections, load bearing sections, etc.) that areseparated by two weaker sections 800 (e.g., connection portions).However, unlike the stent shown in FIG. 5A, the stent shown in FIG. 5Bis not symmetric around the center axis 802 of the ellipse. Thisconfiguration of stronger sections 801 and weaker sections 800 maycreate a higher resistance to crush force in the verticalcross-sectional direction than in the horizontal cross-sectionaldirection while minimizing the vertical weakness of the weaker sections800.

FIGS. 6A-6B illustrate an embodiment of the struts of the weakersections 700, 800 of the stents shown in FIGS. 5A-5B. The struts of theweaker sections may comprise a first strut that has a first strut state900 of FIG. 6A and a second strut state 901 of FIG. 6B. The shape changeof the stent cross-section is discussed further below and references thechanges in strut state to enable/facilitate changes in stent shape. Thefirst strut state 900 of FIG. 6A is partially collapsed. By contrast,the second strut state 901 of FIG. 6B is fully collapsed. The strut maycollapse through an increase in loading. The base of the strut comesinto contact 902 when fully collapsed—such contact at the base of thestrut may prevent further collapse upon additionally increased loading.The deformation from partially collapsed to fully collapsed may bereversible deformation. The weak sections discussed above (i.e., weakersections 700, 800) are created through a series of at least one firststrut(s).

FIGS. 7A-7B illustrate an embodiment of the struts of the strongersections 701, 801 of the stents shown in FIGS. 5A-5B. The struts of thestronger sections may comprise a first strut that has a first strutstate 1000 of FIG. 7A and a second strut state 1001 of FIG. 7B. Thefirst strut state 1000 of FIG. 7A is partially collapsed. By contrast,the second strut state 1001 of FIG. 7B is more collapsed. The strut maycollapse through an increase in loading, just like the weaker struts ofFIGS. 6A-6B—however, collapse of the stronger sections (e.g., shown inFIGS. 7A-7B) requires more force than the collapse of the weakersections (e.g., shown in FIGS. 6A-6B). The shape change of the stentcross-section is discussed further below and references the changes instrut state to enable/facilitate changes in stent shape. The first strutstate 1000 of FIG. 7A is shown substantially unconstrained with littleto no collapse. By contrast, the second strut state 1001 of FIG. 7B isshown partially collapsed, but not completely collapsed. The strut maycollapse through an increase in loading. The deformation from partiallycollapsed to fully collapsed may be reversible deformation. The strongsection discussed above (i.e., stronger sections 701, 801) are createdthrough a series of at least one second strut(s).

The discussion surrounding FIGS. 6A-6B and FIGS. 7A-7B involves, amongother things, creating weaker struts and stronger struts merely usingless material and more material, respectively. While that simplesolution can prove quite effective, it will be understood that manyother ways of creating weaker sections and stronger section exist. Forexample, strut density (i.e., number of struts in a given space) may beincreased for the stronger sections while strut density may be decreasedfor the weaker sections. Alternatively, strut angles (or lack thereof)and prismatic configuration may be used to increase or decrease sectionstrength. Any method or way of creating a stent having sections ofvarying strength may be used.

FIG. 8A illustrates a cross-section of the stent of FIG. 5B incomparison to a maximum reference vessel diameter 1100. The diameter ofthe reference vessel 1101 creates a generally deformable circumferencewhich contains and must compress (at least to some extent) the stent. Inthis case, the circumference of the stent is just less than thecircumference of the maximum vessel diameter. As can be seen, the stent1100 has stronger sections (shown in FIG. 8C) that remain relativelyuncompressed and weaker sections (shown in FIG. 8B) that remainrelatively uncompressed. That is to say (with reference to thedescriptions of FIGS. 6A-6B and 7A-7B, both the stronger struts and theweaker struts are in their first strut state when the stent 1100 is inthis maximum vessel diameter configuration. The maximum (circular)diameter of a blood vessel which can be treated using the devices (e.g.,stents, vascular devices, vascular endoprostheses) disclosed herein isabout 10-23 mm, about 12-22 mm, about 14-21 mm, about 16-20 mm, about17-19 mm, and about 18 mm.

FIG. 9A illustrates a cross-section of the stent 1200 of FIG. 5B incomparison to a minimum reference vessel diameter 1201. The diameter ofthe reference vessel 1201 creates a generally deformable circumferencewhich contains and must compress (to some extent) the stent. Again, thecircumference of the stent is just less than the circumference of themaximum vessel diameter. However, it can be easily seen that the stent1200 of FIG. 9A is more compressed than the stent 1100 of FIG. 8A. Thechange in circumference of the stent from the maximum reference vesselto the minimum reference vessel is achieved substantially through thetransition of the weaker struts from the first strut state to the secondstrut state of the first, weaker struts (though it should be understoodthat some deformation of the stronger struts may be possible). Indeed,Due to the stronger structure of the stronger struts (second strut), thestronger struts stay mostly in their first strut state, although someminor collapse may occur. As can be seen, the stent 1100 has strongersections (shown in FIG. 9C) that remain relatively uncompressed andweaker sections (shown in FIG. 9B) that compress almost completely. Thatis to say (with reference to the descriptions of FIGS. 6A-6B and 7A-7B,the stronger struts remain substantially in their first strut state andthe weaker struts collapse substantially to their second strut statewhen the stent 1100 is in this minimum vessel diameter configuration.The result achieved using this dual-strength or multi-strength (as morethan one strength region may be used) is the sizing at a maximum andminimum reference diameter with minimal radial force (e.g., resistanceof the weak section). The higher radial force of the stronger section ispresent to resist crush of the vessel, but does not impart high radialforce onto the vessel. Therefore, the stent at its minimum vessel sizingmay be significantly circular. The minimum (circular) diameter of ablood vessel which can be treated using the devices (e.g., stents,vascular devices, vascular endoprostheses) disclosed herein is about7-20 mm, about 8-18 mm, about 9-16 mm, about 10-14 mm, about 11-13 mmand about 12 mm.

FIG. 10A illustrates the stent 1300 of FIG. 5B held within andcompressed by a delivery device, e.g., the wall a delivery catheter1301. The transition from the minimum vessel diameter to the crimpeddiameter (e.g., highly compressed diameter, delivery diameter, etc.) isachieved through the transition of the stronger struts from the firststrut state to the second strut state. The weaker struts compress firstand therefore can merely stay in the second strut state. FIGS. 10B and10C illustrate the weaker struts and the stronger struts, respectively,compressed down to their second strut state. The outer diameter of adelivery catheter in which stents, vascular devices, and vascularendoprostheses as disclosed herein may be delivered can be in the rangeof about 7-12 Fr, about 8-11 Fr, about 9-10 Fr, or any other diameterthat can both hold the device and fit through the target vasculature.

FIGS. 11A-11E illustrate various views of an embodiment of an ellipticalstent having stronger sections and weaker sections, as discussed above.FIG. 11A simply illustrates a top/front view of an embodiment of anelliptical stent, showing an elliptical shape. FIG. 11B illustrates athree-quarter view of an embodiment of an elliptical stent. FIG. 11shows that the weak section may comprise only a single first strut 401whereas the stronger section may comprise a series of second struts 400.The single first strut 401 may be stronger than each second strut of theseries of second struts. Alternatively, the single first strut 401 maybe weaker than each second strut of the series of second struts. But,regardless of their individual strength, in this embodiment, the weakersection has less resistance to deformation than does the strongersection. FIG. 11C illustrates a flat pattern view (not necessarily inscale) of an embodiment of an elliptical stent. The stronger section ismade up of several second struts 500 and the weaker section is made upof a single first struts 501 in a vertically repeating pattern. Asshown, the stronger section and the weaker sections do not need to eachcontain the same number of repeating struts. In at least someembodiments, the weak sections are configured so as to not make contactwith each other when in an unconstrained state and in a fully compressedstate. FIG. 11D illustrates a side view of view of an embodiment of anelliptical stent. FIG. 11E illustrates an embodiment of an ellipticalstent similar to that shown in FIG. 11D, except that it includes anangled distal end. This angled distal end may be configured to match thevessel geometry where the left common iliac vein and the right commoniliac vein merge into the inferior vena cava. In such a configuration,the end of the stent having the angled termination may be deployed so asto reside at the merger of the two iliac veins (i.e., the bifurcation ofthe inferior vena cava) while the length of the stent extends distallyor downward into the left common iliac vein. This may advantageouslyserve to provide additional support to the vein(s) at the vena cavalbifurcation. Of course, the stent may have any angle necessary to matcha given patient's anatomy. But, the angle will generally be in the rangeof about 5-45°, about 10-40°, about 15-35°, about 20-30°, or about 25°,or any other angle necessary to fit a patient's vasculature.

FIG. 12 illustrates the same anatomical cross section shown in FIG. 3with the addition of a circular stent 1703 deployed in the left commoniliac vein 1701. To achieve full fill (e.g., full apposition of theexterior surface of the stent against the intraluminal wall) of thevein, the circular stent must exert significant force, denoted by arrows1704, on the right common iliac artery 1700. Levels of force high enoughto achieve clinically meaningful fill of the vein (e.g., substantiallyfull or meaningful apposition of the exterior surface of the stentagainst the intraluminal wall) may result in several adverse effects,including, but not limited to, vessel wear and eventual perforation,increased load on and deformation of the stent causing early fatiguefailure, and/or impedance of blood flow in the right common iliac artery1700, which may result in peripheral arterial disease. Note, thevertebra 1702 of the spine does not displace and is assumedsubstantially rigid with little-to-no give.

FIG. 13 illustrates the same anatomical cross section shown in FIG. 3with the addition of an elliptical stent 1703 deployed in the leftcommon iliac vein. It should be noted that the elliptical stent 1703 ofFIG. 13 has the same circumference as the circular stent 1704 of FIG.12. Use of elliptical stents 1703 may advantageously allow in thecreation of patency in the left common iliac vein 1701 without much ofthe added load cause by the increased height of a circular stent 1703.Using an elliptical stent may advantageously allow a comparatively lowvertical load. To achieve the same low vertical load using a circularstent, a significantly smaller stent would be used. And, such a smallerstent would have a dramatically lower cross-sectional area than theelliptical stent. Reduced load minimizes the likelihood of thecomplication referenced above with respect to circular stents for thetreatment of May-Thurner syndrome (e.g., in the description of FIG. 12),while still providing a similar cross-sectional area to maintain flowand prevent clotting off of the vein. In some embodiments, specificorientation of the pre-loaded or crimped elliptical implant in adelivery catheter is mitigated as certain implant designs disclosedherein may allow for some level of self-alignment. The elliptical stentcan be capable of self-orientation in a compressed vein: the high radialforce vs. low radial force of the elliptical design could cause theimplant to rotate/orient itself such that the higher radial force/crushresistance section (long axis) is perpendicular to the compressionforce. Due to the constraints on the left common iliac vein 1701 fromthe right common iliac artery 1700 and the L5 lumbar vertebra 1702, theelliptical stent can be deployed at an angle up to but not including 90degrees from horizontal and self-align back to horizontal.

In some embodiments, a hybrid stent including at least a first sectioncomprising an elliptical stent portion and at least a second sectioncomprising another, different stent portion, is provided. FIG. 14illustrates a schematic view of a hybrid stent having a first section2200 a second section 2202 and a third transitional section 2201, whichtransitions from the first section to the second section. In someembodiments, the first section 2200 of the hybrid stent is an ellipticalstent such as disclosed elsewhere herein. In some embodiments, thesecond section 2202 comprises a portion of a stent having high radialforce circular stent with flexible axial length. In other embodiments,the second section 2202 may comprises any other type of stent, includingthose disclosed herein. In some embodiments, the third section 2201gently or gradually transitions from the stent of the first section 2200to the stent of the second section 2202 so as to conform best to thepatient's vasculature. Such hybrid stents may advantageously proveuseful in the simultaneous treatment of May-Thurner syndrome and anaccompanying deep venous thrombosis, such as deep venous thrombosis inthe iliac and common femoral vein.

In some embodiments, vascular endoprostheses for the treatment of deepvenous thrombosis, including in the iliac and common femoral veins, areprovided, including vascular endoprostheses (e.g., stents) having highradial force and flexibility along their length. FIGS. 14A-14Cillustrate various view of an embodiment of a stent (e.g., a circularstent) having both high radial force and flexibility along its length.FIG. 14A illustrates the stent from its front or top (i.e.,perpendicular to the stent's longitudinal axis) while FIG. 14Cillustrates the stent from a three-quarter's perspective or an isometricview. FIG. 14B illustrates the flat pattern of the stent. The patternconsists of large “Z” cell patterns 1900 and small “Z” cell patterns1901. The staggered “Z” cell pattern allows for a high radial forcealong with maintained flexibility along the length of the stent. The “Z”patterns repeat along the length of the stent (e.g., vertical) butalternates in orientation along the diameter (e.g., horizontal) of thestent. The “Z” cell pattern is defined by large “Z” struts 1902, small“Z” struts 1903, and crossing link struts 1904.

FIG. 15 illustrates a single “Z” strut of the stent shown in FIGS.14A-14C in various positions. The middle “Z” strut is shown in the “Z”strut's relaxed or unconstrained position 2102. The most compressed “Z”strut is shown in the “Z” strut's compressed state 2100. And, the mostspread out “Z” strut is shown in the “Z” strut's stretched state 2101.In some embodiments, the “Z” structure of the struts can advantageouslyallow each segment of the stent to independently articulate under loads,such as in bending. When the stent is bending, the top of the “Z” jointis in tension (e.g., absorbed by stretched state 2101) and the bottom ofthe arch is in compression (e.g., absorbed by compressed state 2011).

Currently available venous implants often lack the appropriate radialforce necessary to resist compression and recoil of scarred, diseasedveins while providing sufficient flexibility to account for thetortuosity and physiology of the peripheral venous system. In someembodiments, a venous implant for treating ilio-femoral venous outflowobstruction, vein compression, and venous insufficiency disease andmethods for deploying such an implant are provided. The implant mayprovide a high radial force along with flexibility along its length andmay be manufactured from self-expanding Nitinol. The implant may havesufficient radial force to resist compression/recoil of the diseasedvein while providing flexibility and fatigue resistance. Additionally,the implant includes sufficient radial force to resistcompression/recoil of scarred, diseased vein, while providingflexibility to resist kinking and good fatigue resistance. In someembodiments, the vascular implant is self-expanding.

In some embodiments, an implant comprises a cylindrical, self-expandingstent (e.g., made of a shape-memory material, such as Nitinol) withindividual circumferential stent frame/cell geometries joined byflexible bridge members. Repetition of such individual stent cells andflexible bridge members may make up the final diameter and total lengthof the stent. FIG. 16 illustrates an exemplary “equation” for thecreation of such a stent. As can be seen on the left side of the“equation,” a first single cell may be joined to a second single cellusing two (or more) bridge members thereby forming a flexible construct.Multiple, if not many of these flexible constructs may be joinedtogether to form a network. Alternatively, the flexible constructs mayall be cut from a single tube. FIG. 18 illustrates a network of flexibleconstructs formed of cells and flexible bridge members. FIG. 17illustrates a strut configuration that can give the resultant stent ahigh radial force. Flexible bridge members can be placed to joinindividual stent frame/cell geometries in alternate configurationsresulting in different flexibility characteristics of the final stent.In some embodiments, the bridge members join the individual stentframe/cell geometry in a straight line continuous repeating pattern, asshown in FIG. 18. In other embodiments, the bridge members can be placedat varying intervals or in a helical or multi-helical configurations.FIGS. 19A and 19B illustrate additional flexible bridge membergeometries—FIG. 19A is the same as FIG. 19B except that it is shown flatwhile FIG. 19B is shown as it would appear in a stent.

In some embodiments an implant is provided that has an expandedimplantation size that may be selectively adjustable across a range ofdiameters. FIGS. 20A-20H illustrate various views of an implantmanufactured from a super-elastic and/or shape memory tube (e.g.,Nitinol) and laser cut with a series of engaging fingers or teeth. FIG.20A illustrates the implant flat and laid out, with interlocking fingersat opposite ends of the implant. FIG. 20B illustrates a three-quartersview of the implant in its tubular conformation with at least some ofthe interlocking fingers being engaged. FIG. 20C illustrates a side viewof the implant (perpendicular to the implant's longitudinal axis)showing a close-up of the interlocking fingers. FIG. 20D illustrates afront or top view of the implant. FIG. 20E illustrates the implant priorto expansion, finger interlocking, and deployment (in this figure nofingers are interlocked). FIG. 20F illustrates a top or front view ofthe implant showing the diameter prior to expansion/deployment (diameterD1). FIG. 20G illustrates the implant after expansion, fingerinterlocking, and deployment (in this figure at least some fingers areinterlocked). FIG. 20H illustrates a top or front view of the implantshowing the diameter after expansion/deployment (diameter D2). As can beseen, the diameter of the implant afterdeployment/expansion/interlocking of fingers (i.e., D2) is larger thanthe diameter of the implant before deployment/expansion/interlocking offingers (i.e., D1).

To deploy the implant, the implant may be radially compressed/crimped toa smaller diameter for loading onto/into a delivery catheter. Theimplant may be crimped over a balloon on the inner core of the deliverysystem which may be later inflated to expand the coiled implant to thedesired diameter. The engagement fingers are pre-configured at specificlocations to allow discrete incremental expansion of the stent. In someembodiments, the implant can be expanded in 0.5 mm increments. In someembodiments more than one implant may be joined together. For example,the ultimate length of the implant can be controlled by joining anydesired number of individual adaptive diameter cells via flexible orrigid bridge members.

Implants such as those described above may be advantageously provide anadaptive diameter and/or flexibility to conform the dynamic movement ofperipheral veins in leg/pelvis thereby facilitating treatment of bothiliac vein compression syndrome and ilio-femoral venous outflowobstructions.

It may be desirable to have a stent that will conform to the existingpath of a vein instead of a straightening out of the vessel by thestent. It may also be desirable to have a high radial stiffness of thestent to resist collapse of the stent under crushing load and tomaximize the resultant diameter of the treated vessel at the location ofthe stent deployment. With most stent constructions there is a directrelationship between radial stiffness and axial stiffness.

Common commercially available balloon expandable stents experience adramatic change in length as a balloon is used to expand the stentwithin the vessel. Common commercially available self-expanding stentsexperience a change in length less dramatic, but still substantial,which increases with increasing stent length. Change in length betweenthe configuration within the delivery system and when deployed in thevessel causes difficulty in placing/landing the stent precisely at thetarget location. When the stent is deployed in its crimped configurationand expanded, the shortening in length causes the stent targetdeployment location to have to offset from the target dwell location.The magnitude of this effect is not controllable or easily anticipatedas it is dependent on the luminal cross-section along the length of thetarget dwell location (which is frequently and unexpectedly influencedby residual stenosis, irregular shape due to external objects, and/orforces, etc.). For target lesions leading up to the junction of the leftand right iliac into the IVC, this causes difficulty in placing thestent to dwell completely within the iliac along its total length up tothe junction to the inferior vena cava without crossing into theinferior vena cava.

In some embodiments a venous stent with high radial force, no impactfulforeshortening along multiple lengths, and high flexibility/vesselconformity is provided. Minimization of foreshortening allows the stentadvantageously accurate and predictable deployment. And, highflexibility maximizes the fatigue life of the stent under bending. Ofcourse, it will be understood that the stent may find applications inthe arterial system as well.

FIGS. 21A-21D illustrate various views of an embodiment of a stentconfigured to minimize foreshortening while retaining flexibility. Thestent 100, which may be self-expanding, consists of a series ofcircumferentially adjacent closed cells 200 that define at least twoaxially repeating rings 301. Each axially repeating ring 301 has aninner diameter 101, an outer diameter 103, and a length 203. Each ringis connected by pairs of linkage struts 202 with the total length of therepeating rings 102 and linkage struts 202 defining the length of thestent. In some embodiments, the closed cells 200 may be defined by anenclosed perimeter.

The linkage struts 202 attach to the rings 301 at or near the attachmentof each adjacent closed cell 202 in the ring 301. In this way, thelinkage struts 202 are connected to portions of the rings 301 that neverchange axially upon compression or expansion of the ring—thisadvantageously improves the foreshortening properties of this stent. Insome embodiments, the linkage struts 202 are configured in pairs tomirror each other on opposite sides of the stent 303 when the flatlaser-cut pattern (shown in FIG. 21B) is cut into a tube as in FIGS. 21A& 21C. Is some embodiments, adjacent linkage struts 202 are positionedwith at least one axially indexed cell rotation around the axis creatinga spiral orientation of linkage struts 202 connecting the rings 301.

The stent has a first unconstrained/uncompressed configuration, shown inFIG. 21A, that is defined by a first diameter 101 and a first length102. The stent also has a second crimped configuration, shown in FIG.21D, that is defined by a second diameter 401 (that is less than thefirst diameter 101) and a second length 402. Because the linkage struts202 are attached only at points on the rings 301 that do not moveaxially, the first length 102 and the second length 402 aresubstantially the same. There is only very little change in length onlyfrom the 1st half and trailing cell. In some embodiments, the length ofthe struts prevents contact of the cells in axially adjacent rings frommaking contact in the first unconstrained/uncompressed configuration andthe second crimped configuration. In some embodiments, the spacingbetween the joining of the cells in the unconstrained state at the firstend 104 and second end 105 substantially equals the spacing between thejoining of the cells in the crimped state at the first end 404 and thesecond end 405. In some embodiments, there is a radiopaque marker at thejoining location of the cells at the first end 104, 404 and second end105, 405.

Some embodiments disclosed herein, such as those shown in FIGS. 21A-21D,decouple the relationship between radial stiffness and axial stiffnessthrough their configuration of individual one cell long rings fixedtogether at the joining of the cells of each ring through the linkagestruts. This allows for maintenance of controlled spacing by the linkagestrut between the joined rings along a pathway but gives them thefreedom to orient with the axis of one ring being different than theaxis of the adjacent rings. The individual rings, with a relatively lowaxial flexibility, orient themselves largely straight along theirindividual length with the bending happening substantially along thelinkage struts which are characterized by a much higher axialflexibility. Therefore, radial force can be controlled by the width ofthe cell struts and kept independent of the axial flexibility that iscontrolled by the width of the linkage struts. Additionally, the axiallyrotated indexing position of each adjacent pair of linkage struts,creating a spiral orientation of linkage struts, ensures that the stenthas substantially similar axial flexibility regardless of angularorientation around its axis.

With each cell connected at the attachment of the struts, there is nochange in position of one cell to the adjacent cells when the stent isfully crimped and when it's fully unconstrained. Therefore, the onlyforeshortening of the stent would come from half of the leading cell andhalf of the trailing cell. Also, the foreshortening of the presentedinvention is the same regardless of stent overall length given equallyconfigured cells (increasing length by adding more rings). When thepresented invention is deployed into the iliac-inferior vena cava (asdiscussed above), the location of the stent within the delivery systemwill equal the location of the stent when deployed form the deliverysystem into the vessel. The positioning and deployment of the stent willbe the same regardless of the stent length. Therefore, a marker locatedat the connection of the cells/attachment of the struts can giveexcellent visualization and indication of the position of the stent whenin the delivery system and when deployed in the vessel.

Currently available implants are typically loaded and retained onto adelivery system in a crimped configuration and then navigated anddeployed in the desired anatomical location where they expand to theimplanted configuration. The final implanted configuration can beachieved through mechanical expansion/actuation (e.g.,balloon-expandable) or self-expansion (e.g., Nitinol). Self-expandingimplants are manufactured from super elastic or shape memory alloymaterials. Accurate and precise deployment of a self-expanding implantcan be challenging due to a number of inherent design attributesassociated with self-expanding implants. The implant may jump/advancefrom the distal end of the delivery system during deployment due to thestored elastic energy of the material. Additionally, the implant mayforeshorten during deployment due to the change in the implant diameterfrom the crimped configuration to the expanded configuration. Finally,physiological and anatomical configurations, such a placement at or nearbifurcations of body lumens, can affect accurate placement of implants.Once the implant in placed within the body lumen there is potential foruneven expansion or lack of circumferential implant apposition to thebody lumen which can result in movement, migration or in certain severecases implant embolization.

In some embodiments, a self-expanding implant designed with sufficientradial force to resist constant compression of the body lumen whileproviding optimal fatigue resistance, accurate placement, and in-vivoanchoring to prevent is provided. Additionally, various methods fordeployment and implantation for treating iliac vein compression syndromeand venous insufficiency disease are provided.

In some embodiments, the implant comprises a purposely designed venousimplant intended to focally treat iliac vein compression (May-ThurnerSyndrome). The implant may be relatively short in length (˜40 mm) andmay be manufactured from self-expending Nitinol with integrated anchorfeatures to aid in accurate placement and to mitigate migrationfollowing implantation. The implant and delivery system are designed forprecise deployment and placement at the bifurcation of the inferior venacava into the right and left common iliac veins.

FIGS. 22A-22E illustrate various views of an intravascular stent havinga plurality of anchor members. FIG. 22A illustrates the stent in asubstantially cylindrical configuration. FIG. 22B illustrates the stentin a flat, laser cut pattern. FIGS. 22C and 22D illustrate the stent ina substantially uncompressed state. FIG. 22E illustrates the stentimplanted within the left common iliac vein at the bifurcation of theinferior vena cava.

In one embodiment, the stent comprises a cylindrical self-expandingNitinol structure with anchor features integrated into the stent framecell pattern that are heat set into an angled configuration, thusresulting in anchor features circumferentially protruding outward fromthe base diameter of the stent when deployed. When the stent implant iscrimped and loaded into a delivery catheter the anchors are constrainedby the outer sheath of the delivery catheter thus allowing them to beflush with the base diameter of the stent.

As can be seen in FIG. 22B, the first set of anchor features may be setback a distance DIM ‘A’ from the distal end of the stent, thus allowingthe stent to be partially deployed from the delivery system allowing theoperator to finely reposition the entire delivery system as necessarysuch to align the distal end of the implant at the target deploymentlocation. Once the distal end of the partially deployed stent is in theappropriate deployment location, the remainder of the stent can bedeployed and the anchor features will engage the vessel wall upondeployment from the delivery catheter.

The anchor features may aid in accurate and precise deployment at thetarget implantation location of the stent. For example, engagement ofthe anchor features in the vessel wall may mitigate jumping of theimplant from the delivery system and missing the target implantationlocation due to the expansion energy from self-expanding implants.Moreover, distal to proximal engagement of the anchor features in thevessel wall during deployment may serve to mitigate foreshortening ofthe implant in the distal-to-proximal direction. As the distal end ofthe implant is first anchored against the vessel wall the implant canonly foreshorten in the proximal-to-distal direction during deploymentas the distal end of the implant is fixed/anchored against the vesselwall. And, following implantation of the stent, the anchor features mayhelp mitigate migration of the implant.

FIGS. 23A-23F show various potential configurations of anchors that maybe used with the intravascular stent of FIGS. 22A-22E.

In another embodiment, shown clearly in FIGS. 22C and 22D, the implantwith anchor features consists of a cylindrical self-expanding Nitinolstent with distal flared section. The distal flared section iscontrolled by radius ‘r’. The flared distal end of the stent may be usedfor placement of the stent at a bifurcation of two vessels as shown inFIG. 22E.

The pre-loaded stent configuration on the delivery system allows thedistal flared section of the stent to be partially deployed from thedelivery system allowing the operator to position the flared section ofthe stent at the bifurcation of two vessels. The delivery catheter isadvanced distal to the vessel bifurcation to be treated, in this casethe left common iliac vein. Using the radiopaque markers on the implant,the operator can seat the partially deployed flare section of the stentat the bifurcation junction. Once the distal flared end of the partiallydeployed stent is in the appropriate deployment location and seated atthe bifurcation junction the remainder of the stent can be deployed andthe anchor features can engage the vessel wall upon deployment from thedelivery catheter.

The implant shown in FIGS. 22A-23F may advantageously facilitateaccurate and precise deployment of the stent implant, prevent migrationof the stent implant following deployment, and mitigate protuberance ofthe stent implant into the inferior vena cava (causing hemodynamicinsufficiencies) when treating iliac vein compression syndrome(May-Thurner syndrome).

Although this invention has been disclosed in the context of certainpreferred embodiments and examples, it will be understood by thoseskilled in the art that the present invention extends beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the invention and obvious modifications and equivalentsthereof. In addition, while a number of variations of the invention havebeen shown and described in detail, other modifications, which arewithin the scope of this invention, will be readily apparent to those ofskill in the art based upon this disclosure. It is also contemplatedthat various combinations or sub-combinations of the specific featuresand aspects of the embodiments may be made and still fall within thescope of the invention. Accordingly, it should be understood thatvarious features and aspects of the disclosed embodiments can becombined with or substituted for one another in order to form varyingmodes of the disclosed invention. Thus, it is intended that the scope ofthe present invention herein disclosed should not be limited by theparticular disclosed embodiments described above, but should bedetermined only by a fair reading of the claims that follow.

Similarly, this method of disclosure, is not to be interpreted asreflecting an intention that any claim require more features than areexpressly recited in that claim. Rather, as the following claimsreflect, inventive aspects lie in a combination of fewer than allfeatures of any single foregoing disclosed embodiment. Thus, the claimsfollowing the Detailed Description are hereby expressly incorporatedinto this Detailed Description, with each claim standing on its own as aseparate embodiment.

While various embodiments of the present invention have been describedabove, it should be understood that they have been presented by way ofexample only, and not limitation. It will be apparent to persons skilledin the relevant art that various changes in form and detail can be madetherein without departing from the spirit and scope of the presentinvention. Thus, the breadth and scope of the present invention shouldnot be limited by any of the above-described exemplary embodiments, butshould be defined only in accordance with the following claims and theirequivalents.

What is claimed is:
 1. A self-expanding stent, comprising: a pluralityof rings adjacently positioned along a longitudinal axis of the stent,each of the rings including a plurality of struts interconnected to formalternating apexes and troughs; and a plurality of flexible bridgemembers extending between adjacent pairs of the plurality of rings andconnecting to at least one of the apexes to connect the adjacent pairs,wherein the flexible bridge members are formed in a plurality ofdifferent geometries and the geometry of the flexible bridge membersvaries from one pair of connected rings to the next adjacent pair ofconnected rings along the longitudinal axis of the stent, wherein theplurality of different geometries of flexible bridge members comprisegenerally s-shaped bridge members with two rounded bends, generallyz-shaped bridge members with two acutely-angled bends, and nestingelongated generally z-shaped bridge members; wherein the generallys-shaped bridge members extending between adjacent pairs of theplurality of rings include a plurality of generally s-shaped bridgemembers extending between a first pair of rings of the plurality ofrings, and wherein each of the plurality of generally s-shaped bridgemembers is connected to a pair of apexes aligned with one another in thedirection of the longitudinal axis.
 2. The stent of claim 1, wherein foreach pair of connected rings, the flexible bridge members connectbetween at least one apex of one of the rings to at least one apex ofanother one of the rings.
 3. The stent of claim 2, wherein for each pairof connected rings, the flexible bridge members connecting the pair ofconnected rings are spaced in a circumferential direction around thelongitudinal axis such that each connected apex is separated fromanother connected apex by at least one unconnected apex.
 4. The stent ofclaim 1, wherein for each pair of connected rings, the geometry of eachof the flexible bridge members connecting the pair of connected rings isthe same.
 5. The stent of claim 1, wherein along the longitudinal axisof the stent: a second pair of rings directly adjacent the first pair ofrings are connected by the generally z-shaped bridge members; a thirdpair of rings directly adjacent the first pair of rings are connected bythe generally z-shaped bridge members; and a fourth pair of ringsdirectly adjacent the third pair of rings are connected by the nestingelongated z-shaped bridge members.
 6. The stent of claim 1, wherein theflexible bridge members connecting at least one pair of connected ringscomprise at least three bridge struts, the bridge struts neitherparallel nor perpendicular to the longitudinal axis of the stent suchthat the flexible bridge members generally comprise two acute angles. 7.The stent of claim 6, wherein, along the longitudinal axis of the stent,the flexible bridge members connecting at least one pair of connectedrings located to one side of a longitudinal midpoint of the stentcomprise a bridge strut generally oriented in a first direction at anoblique angle relative to the longitudinal axis of the stent, and theflexible bridge members connecting at least one pair of connected ringslocated to another side of the longitudinal midpoint of the stentcomprise a bridge strut generally oriented in a second directionopposite the first direction at an oblique angle relative to thelongitudinal axis of the stent.
 8. A self-expanding stent, comprising: aplurality of rings adjacently positioned along a longitudinal axis ofthe stent, each of the rings including a plurality of strutsinterconnected to form alternating apexes and troughs; and a pluralityof flexible bridge members extending between apexes of adjacent pairs ofthe plurality of rings to connect the adjacent pairs, wherein theflexible bridge members are formed in a plurality of differentgeometries and the geometry of the flexible bridge members varies fromone pair of connected rings to the next adjacent pair of connected ringsalong the longitudinal axis of the stent, wherein the plurality ofdifferent geometries of flexible bridge members comprise generallys-shaped bridge members with two rounded bends, generally z-shapedbridge members with two acutely-angled bends, and nesting elongatedgenerally z-shaped bridge members, wherein the generally z-shaped bridgemembers extending between adjacent pairs of the plurality of ringsinclude a plurality of generally z-shaped bridge members extendingbetween a first pair of rings of the plurality of rings, and whereineach of the plurality of generally z-shaped bridge members is connectedto a pair of apexes aligned with one another in the direction of thelongitudinal axis.
 9. The stent of claim 8, wherein along thelongitudinal axis of the stent: a second pair of rings directly adjacentthe first pair of rings are connected by the generally s-shaped bridgemembers; a third pair of rings directly adjacent the second pair ofrings are connected by the generally z-shaped bridge members; and afourth pair of rings directly adjacent the third pair of rings areconnected by the nesting elongated generally z-shaped bridge members.10. The stent of claim 8, wherein for each pair of connected rings, theflexible bridge members connecting the pair of connected rings arespaced in a circumferential direction around the longitudinal axis suchthat each connected apex is separated from another connected apex by atleast one unconnected apex.
 11. The stent of claim 8, wherein for eachpair of connected rings, the geometry of each of the flexible bridgemembers connecting the pair of connected rings is the same.
 12. Aself-expanding stent, comprising: a plurality of rings adjacentlypositioned along a longitudinal axis of the stent, each of the ringsincluding a plurality of struts interconnected to form alternatingapexes and troughs; and a plurality of flexible bridge members extendingbetween apexes of adjacent pairs of the plurality of rings to connectthe adjacent pairs, wherein along the longitudinal axis of the stent: afirst pair of rings are connected by a first set of generally z-shapedbridge members, each of the generally z-shaped bridge members of thefirst set having two acutely-angled bends and a first angularorientation in a first direction and being connected to a pair of apexesaligned with one another in the direction of the longitudinal axis, asecond pair of rings directly adjacent the first pair of rings areconnected by generally s-shaped bridge members, each of the generallys-shaped bridge members having two rounded bends and being connected toa pair of apexes aligned with one another in the direction of thelongitudinal axis, a third pair of rings directly adjacent the secondpair of rings are connected by a second set of generally z-shaped bridgemembers, each of the generally z-shaped bridge members of the second sethaving two acutely-angled bends and a second angular orientation in asecond direction that is generally opposite the first angularorientation and first direction, and a fourth pair of rings directlyadjacent the third pair of rings are connected by nesting elongatedz-shaped bridge members.
 13. The stent of claim 12, wherein for eachpair of connected rings, the flexible bridge members connecting the pairof connected rings are spaced in a circumferential direction around thelongitudinal axis such that each connected apex is separated fromanother connected apex by at least one unconnected apex.
 14. The stentof claim 13, wherein along the longitudinal axis of the stent: thegenerally z-shaped bridge members connecting the first pair of rings arespaced in the circumferential direction such that each connected apex isseparated from another connected apex by three unconnected apexes; thegenerally s-shaped bridge members connecting the second pair of ringsare spaced in the circumferential direction such that each connectedapex is separated from another connected apex by one unconnected apex;the generally z-shaped bridge members connecting the third pair of ringsare spaced in the circumferential direction such that each connectedapex is separated from another connected apex by three unconnectedapexes; and the nesting elongated z-shaped bridge members connecting thefourth pair of rings are spaced in the circumferential direction suchthat each connected apex is separated from another connected apex by oneunconnected apex.
 15. The stent of claim 12, wherein for each pair ofconnected rings, the geometry of each of the flexible bridge membersconnecting the pair of rings is the same.